Dual Eligibles Best Practices Summitt

The recent summit sponsored by www.risehealth.org addressed lessons learned as well as provider and payer experiences in addressing the most immediate needs for this high cost population.What to expect when you focus on identifying and addressing social, environmental and behavioral health barriers. The dual eligible population which is , as of January 2017 over 2.2 million is covered by 52 health plans .Forty-one percent of Medicare-Medicaid enrollees have at least one mental health diagnosis.while 60% have  multiple chronic conditions.In 2011,Medicare-Medicaid enrollees accounted for approximately  $ 294 billion in federal and state spending, of which $180 billion was Medicare  spending and 114 billion was Medicaid spending.

Opportunities to transform the delivery of care was addressed by many of the presenters. Since ” duals” account for 21% of total Medicare population but consume 35% of spending. They have higher rates of chronic disabilites as well as higher disease burden with current  behaviorlal health diagnosis There is higher proportion of Part D medication and lastly, the duals represent a lower socioeconomic status.

In assessing strategies providers,payers and care management providers need to address basic primary care services advanced management  and integrated best practice care management. We have a challenge but we have solutions.

 

 

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By Bill Shaw

William " Bill " Shaw has been in the health care sector for over 30 years. After leaving management positions at Fortune 200 companies. such as The Upjohn Company, Kidde, The Travelers and Cigna he started William M Shaw & Associates, health care consulting. He has written and presented at many industry conferences . He has supported over 80 companies, start-ups in their positioning in the managed care, long term care and nice service/product space.